{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T05:30:18Z","timestamp":1792301418058,"version":"4.4.0"},"reference-count":46,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2023,5,1]]},"abstract":"Importance<\/jats:title>Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS\/TEN) are severe cutaneous adverse reactions, and patients with SJS\/TEN frequently require intensive care. However, there is limited evidence on the clinical outcomes of immunomodulating therapy, including plasmapheresis and intravenous immunoglobulin (IVIG) in patients with SJS\/TEN.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare clinical outcomes of patients with SJS\/TEN who were treated with plasmapheresis first vs IVIG first after ineffective systemic corticosteroid therapy.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study used data from a national administrative claims database in Japan that included more than 1200 hospitals and was conducted from July 2010 to March 2019. Inpatients with SJS\/TEN who received plasmapheresis and\/or IVIG therapy after initiation of at least 1000 mg\/d of methylprednisolone equivalent systemic corticosteroid therapy within 3 days of hospitalization were included. Data were analyzed from October 2020 to May 2021.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Patients who received IVIG or plasmapheresis therapy within 5 days after initiation of systemic corticosteroid therapy were included in the IVIG- and plasmapheresis-first groups, respectively.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>In-hospital mortality, length of hospital stay, and medical costs.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 1215 patients with SJS\/TEN who had received at least 1000 mg\/d of methylprednisolone equivalent within 3 days of hospitalization, 53 and 213 patients (mean [SD] age, 56.7 [20.2] years; 152 [57.1%] women) were included in the plasmapheresis- and IVIG-first groups, respectively. Propensity-score overlap weighting showed no significant difference in inpatient mortality rates between the plasmapheresis- and IVIG-first groups (18.3% vs 19.5%; odds ratio, 0.93; 95% CI, 0.38\u20132.23; P<\/jats:italic> = .86). Compared with the IVIG-first group, the plasmapheresis-first group had a longer hospital stay (45.3 vs 32.8 days; difference, 12.5 days; 95% CI, 0.4\u201324.5 d; P<\/jats:italic>\u2009=\u2009.04) and higher medical costs (US $34\u202f262 vs $23\u202f054; difference, US $11\u202f207; 95% CI, $2789\u2013$19\u202f626; P<\/jats:italic>\u2009=\u2009.009).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This nationwide retrospective cohort study found no significant benefit to administering plasmapheresis therapy first instead of IVIG first after ineffective systemic corticosteroid treatment in patients with SJS\/TEN. However, medical costs and length of hospital stay were greater for the plasmapheresis-first group.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2023.0035","type":"journal-article","created":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T16:09:45Z","timestamp":1678291785000},"page":"481","source":"Crossref","is-referenced-by-count":30,"title":["Evaluation of Plasmapheresis vs Immunoglobulin as First Treatment After Ineffective Systemic Corticosteroid Therapy for Patients With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis"],"prefix":"10.1001","volume":"159","author":[{"given":"Yuki","family":"Miyamoto","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan"},{"name":"Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, 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